Leading causes of cancer-specific mortality in the English and Dutch-speaking Caribbean region

OBJECTIVE: This study examined cancer-related mortality rates among the 21 Caribbean countries that submitted mortality data to the Caribbean Public Health Agency. METHODS: We calculated proportions and age-standardized mortality rates (ASMR) by cancer site and gender for each country using the most recent five years of mortality data available from 2003 to 2013. Calculations were completed using SEER*Stat software and the world (Segi 1960) standard million population. RESULTS: Age-standardized mortality rates for all cancers combined ranged from 46.1 to 139.3 per 100 000. Among males, prostate cancer was the most common cause of cancer deaths in all countries, accounting for 18.4–47.4% of cancer deaths, and an ASMR of 15.1 to 74.1 per 100000. Lung cancer (4.6–34.0 per 100 000) was the second or third leading cause of cancer deaths among males in most countries. Among females, breast cancer was the most common cause of cancer deaths in 16 of 18 countries(with > 6 reported cases), accounting for 16.1–30% of cancer deaths and an ASMR of 10.0 to 27.3 per 100 000. The ASMR of cervical cancer was higher than the world average (6.8 per 100 000) in 11 countries, and accounted for 4.5–18.2% of cancer deaths. CONCLUSION: There is great variability in cancer-specific mortality rates within the Caribbean region; however, prostate and breast cancers are consistently the leading causes of cancer-related deaths among males and females, respectively. Lung and cervical cancers–cancers for which World Health Organization “best buy” interventions exist–are also important causes of mortality in many countries.

Germline Wilms tumor suppressor gene (WT1) mutation leading to isolated genital malformation without Wilms tumor or nephropathy.

Mutations of the Wilms tumor suppressor gene (WT1 ) have been described only in patients with syndromes associated with urogenital malformation and Wilms tumor or nephropathy. We present a male patient with an isolated genital malformation caused by a WT1 mutation.

[Endoscopic laser lithotripsy for difficult calculi after unsuccessful extracorporeal shock wave lithotripsy]. / Litotripsia endoscópica à laser em cálculos difíceis não responsivos à litotripsia extracorpórea por ondas de choque.

INTRODUCTION: More than 97% of common bile duct stones can be successfully managed by endoscopic papillotomy, mechanical lithotripsy and extracorporeal shock-wave lithotripsy. In this study, we evaluate the role of laser lithotripsy after failure of the above mentioned endoscopic methods. PATIENTS AND METHODS: Eighteen patients (15F, 3M; median age = 69 (28-83) years) were treated by endoscopic laser lithotripsy after ESWL failure. We employed a Rhodamine-6 G laser with a stone-tissue recognizing system. The laser fibers were cholangioscopically (direct vision) or blindly (under plain fluoroscopic control) placed. RESULTS: Seventeen patients were treated endoscopically and one was successfully managed percutaneously after failure of the transpapillary approach. Fourteen (78%) were stone-free after a mean of 1.56 laser therapy sessions alone. Two additional patients were successfully managed after partial fragmentation with combined treatment (mechanical lithotripsy: n = 1, electrohydraulic lithotripsy: n = 1). Overall, 89% of the patients were freed from their calculi. Cholangitis occurred once and the mortality was zero. CONCLUSIONS: We conclude that laser lithotripsy is an effective and safe treatment alternative in a highly selected patient population with difficult bile duct stones and considerable surgical risk.